A Prospective Evaluation of the Diagnostic Accuracy of the Physical Examination for Pulmonary Hypertension
A Prospective Evaluation of the Diagnostic Accuracy of the Physical Examination for Pulmonary Hypertension
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DOI：
10.1016/j.chest.2019.01.035
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发表时间：
2019-05-01
期刊：
影响因子：
9.6
通讯作者：
Weatherald, Jason
中科院分区：
文献类型：
--
作者：
Braganza, Michael;Shaw, Jeffrey;Weatherald, Jason
背景：体格检查结果对肺动脉高压（PH）的有用性尚未得到很好的证实。本研究的目的是前瞻性评估体格检查对ph检测的诊断性能。方法：连续接受右侧心导管插入术的患者（n = 116）由主治医师、住院医师和医学生采用盲法进行检查。计算每个物理发现的敏感性、特异性和阳性和阴性似然比（LRs）。采用线性回归法比较颈静脉搏动（JVP）高度与右房压（RAP）。使用单变量和多变量逻辑回归评估体格检查与PH之间的关系。结果：PH患病率为87%。只是一个简称JVP > 3厘米(积极的LR, 2.5; 95%置信区间,1.2 - -5.4)和肺动脉瓣返流杂音(特异性,100%;95%置信区间,79% -100%)帮助统治博士没有简称JVP > 3厘米(- LR, 0.4; 95%置信区间,0.3 - -0.6)和没有响亮的肺的组件的第二心音(- LR, 0.5; 95%置信区间,0.3 - -0.9)在扣除博士简称JVP适度的实用性与说唱(r = 0.59; P <措施),但往往导致低估说唱(意味着偏见,水-3.4厘米;95%一致限，-14.0至7.2)。JVP bbb3cm和胸骨旁隆起的存在区分了PH（曲线下面积[AUC] = 0.75）。JVP > 3 cm、水肿和周围水肿联合判断为重度PH（平均肺动脉压>= 45 mm Hg; AUC = 0.82）。结论：单个体检结果对PH的诊断价值不足。没有综合检查结果可以排除PH，但高JVP、外周水肿和胸骨旁隆起的存在提示严重的PH。
BACKGROUND: The usefulness of physical examination findings for pulmonary hypertension (PH) is not well established. The purpose of this study was to evaluate prospectively the diagnostic performance of the physical examination for detecting PH.METHODS: Consecutive patients undergoing right-sided heart catheterization (n = 116) were examined by an attending physician, medical resident, and medical student in a blinded fashion. Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated for each physical finding. Jugular venous pulsation (JVP) height was compared with right atrial pressure (RAP) by using linear regression. The association between physical findings and PH was assessed using univariate and multivariate logistic regression.RESULTS: The prevalence of PH was 87%. Only a JVP > 3 cm (positive LR, 2.5; 95% CI, 1.2-5.4) and pulmonic regurgitation murmur (specificity, 100%; 95% CI, 79%-100%) helped rule in PH. The absence of JVP > 3 cm (negative LR, 0.4; 95% CI, 0.3-0.6) and absence of loud pulmonic component of the second heart sound (negative LR, 0.5; 95% CI, 0.3-0.9) had modest usefulness in excluding PH. JVP correlated with RAP (r = 0.59; P < .001) but tended to lead to underestimation of RAP (mean bias, -3.4 cm H2O; 95% limits of agreement, -14.0 to 7.2). The presence of JVP > 3 cm and a parasternal heave discriminated PH (area under the curve [AUC] = 0.75). The combination of JVP > 3 cm, heave, and peripheral edema discriminated severe PH (mean pulmonary arterial pressure >= 45 mm Hg; AUC = 0.82).CONCLUSIONS: Individual physical examination findings have inadequate diagnostic usefulness for PH. No combination of findings can be used to exclude PH, but the presence of high JVP, peripheral edema, and parasternal heave suggests severe PH.